Outline

Objective

Chronic anterior uveitis in children often takes a serious course. In many of these children the uveitis is associated with juvenile idiopathic arthritis. Treatment consists of local or systemic immunosuppression. Despite various immunosuppressive drugs some children do not sufficiently respond to this treatment with a high risk of becoming severely disabled. Until now anti TNF alpha therapy for uveitis has been used in a few children, but the results were not ambiguous. Here we report of 19 patients treated with Etanercept for uveitis, mostly associated with juvenile onset arthritis.

Methods

In a retrospective study 19 patients were treated with Etanercept (0.4mg/kg body weight, twice a week, subcutaneously); 17 also had juvenile idiopathic arthritis, in 2 children no underlying disease was found. The age varied from 13-25 years (mean age 14.6 years). Patients were included when the previous antiinflammatory therapy was not effective. This consisted of systemic steroids (n=19), Cyclosporin A (n=18), Methotrexate (n= 19), Azathioprine (n= 15), Cyclophosphamide (n=2), Immunoglobulins (n=1) and Mycophenolat mofetil (n=2). The grading for uveitis was: effective: no relapse or more than 2 relapses less than before treatment, mild: one relapse less than before treatment, no response: no change in relapse rate, worsening: more relapses under treatment than before. The grading for arthritis (depending on the clinical findings) was: very effective, effective, mild, no response, worsening.

Results

For arthritis the response to Etanercept was very effective in 6 patients, effective in 7 patients, mildly effective in 2 patients, not responding in 1 patient and became worse in 1 patient. For uveitis the response to this treatment was mild in 7 patients, 9 patients did not respond, and 3 patients even worsened their course of uveitis (new relapses after years).

Conclusions

Our results show that the anti TNF alpha drug Etanercept was very effective or at least mildly effective in 15 of 17 (88%) patients for their rheumatoid arthritis. In contrast for uveitis our study shows that only a mild response was found in 37%, not resulting in a completely quiet eye for a longer time, but 47% of patients did not respond at all. Even worse was, that 3 patients (16%) experienced new exacerbations of their uveitis after a long period of quiet disease. So our study suggests that for patients with juvenile uveitis Etanercept may not be very helpful. While highly effective for arthritis, this study confirms previous results, suggesting that Etanercept can even provoke uveitis.